1
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Zhou MX, Viozzi CF, Heneberk O, Lee SK, Klarich KW, Salinas TJ. Oral Health Clearance Outcomes for Cardiovascular Surgery. Mayo Clin Proc Innov Qual Outcomes 2024; 8:121-130. [PMID: 38384717 PMCID: PMC10879629 DOI: 10.1016/j.mayocpiqo.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Objective To determine the risk of morbidity and mortality in patients receiving dental extractions before planned cardiovascular surgery (CVS) and examine factors that may affect the chance of oral health clearance. Patients and Methods A retrospective medical record review was performed of patients who underwent dental screening before CVS from January 1, 2015, to December 31, 2021, at a major medical institution. A total of 496 patients met the inclusion criteria and were divided into 2 groups. Group 1 patients were cleared to advance to planned CVS (n=390). Group 2 patients were not cleared for surgery and subsequently underwent dental extractions before planned CVS (n=106). Results Six patients (5.7%) experienced postoperative complications after dental extraction that resulted in an emergency room visit. No deaths occurred after dental extraction before CVS. However, 4 patients died within 30 days of CVS, 3 from Group 1 (0.77%) and 1 from Group 2 (0.94%). Dental extraction before planned CVS showed a borderline significant association with death based on unadjusted (P=.06) and age-adjusted analysis (P=.05). Patients who reported seeing a dentist routinely had a significantly higher chance of oral health clearance (P <.001). No differences were noted between the 2 groups with regard to age, sex, or 30-day hospital readmission rate. Conclusion Patients who had dental extractions completed before planned CVS may be at an increased risk of mortality. Further studies are needed to examine this relationship. Emphasis should be on prioritization of routine dental visits before planned CVS.
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Affiliation(s)
- Miao Xian Zhou
- Department of Dental Specialties, Mayo Clinic, Rochester, MN
| | | | - Ondřej Heneberk
- Department of Dentistry, University Hospital, Hradec Kralove, Czech Republic
| | - Sarah K. Lee
- Department of Dental Specialties, Mayo Clinic, Rochester, MN
| | - Kyle W. Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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2
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Guinness F, Coleman M, Gillbride M. Dexmedetomidine sedation for a dental extraction in a patient with known difficult airway. Anaesth Rep 2022; 10:e12184. [PMID: 35983243 PMCID: PMC9372726 DOI: 10.1002/anr3.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/08/2022] Open
Abstract
Fibrodysplasia ossificans progressiva is an autosomal dominant condition that causes cervical spine fusion and ankylosis of the temporomandibular joint, resulting in anaesthetic challenges. Awake tracheal intubation with flexible bronchoscopy is recommended for general anaesthetics required by patients with this disease. This case report describes the novel approach of using dexmedetomidine sedation in combination with local anaesthesia to allow dental extraction of the fifth and seventh upper left teeth in a patient with fibrodyplasia ossificans progressive, who had a known difficult airway and profound thrombocytopenia. This procedure was not previously tolerated by the patient under local anaesthesia alone. The use of dexmedetomidine was successful in facilitating completion of the procedure with a high degree of patient satisfaction. We discuss the advantages of dexmedetomidine over other sedative agents due to its minimal effects on respiratory drive and airway muscle tone. We highlight the use of dexmedetomidine for complex cases such as this, where tracheal intubation is potentially challenging, but the procedure itself could be managed under sedation and local anaesthesia.
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Affiliation(s)
- F. Guinness
- Department of AnaesthesiaUniversity Hospital LimerickLimerickIreland
| | - M. Coleman
- Department of AnaesthesiaUniversity Hospital LimerickLimerickIreland
| | - M. Gillbride
- Department of Oral and Maxillofacial SurgeryUniversity Hospital LimerickLimerickIreland
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3
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Costa RF, Bucharles SGE, Kagueiama DE, Kus CP, Andrade ADA, Dirschnabel AJ, de Araujo MR, de Lima AAS. The surgical management of a patient with chronic renal failure and macrothrombocytopenia related to the MYH9 gene mutation: A case report. SPECIAL CARE IN DENTISTRY 2022; 42:651-656. [PMID: 35537118 DOI: 10.1111/scd.12727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
MYH9 disease is a rare genetic disorder in which there is a mutation in the gene for the non-muscle myosin heavy chain IIA. It initially causes macrothrombocytopenia followed by other clinical manifestations. When the patient reaches adulthood, he can develop chronic kidney failure. Thus, the risk of suffering a hemorrhage, difficulty in repairing and, infections increases in individuals with this disease. In addition, the use of drugs in these patients should be carefully evaluated. An adult patient sought dental care with a complaint associated with a tooth with advanced dental caries. He had severe thrombocytopenia (7000 platelets/mm3 ), hearing loss, and chronic kidney failure. The diagnosis of MYH9 disease was confirmed through genotyping. After clinical examination, extraction was planned. Local and systemic procedures were used to prevent hemorrhage, especially postoperatively. Although the patient had an infection at the surgical wound site and no episode of postoperative bleeding, the repair process occurred normally. The purpose of this article is to report the surgical management of a patient with MYH9 disease.
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Affiliation(s)
- Rafael Fiorese Costa
- Department of Stomatology, Universidade Federal do Paraná, Curitiba, PR, Brazil.,Fundação de Amparo a Pesquisa em Enfermidades Renais e Metabólicas, Pró-Renal, Curitiba, PR, Brazil
| | | | - Douglas Eiji Kagueiama
- Fundação de Amparo a Pesquisa em Enfermidades Renais e Metabólicas, Pró-Renal, Curitiba, PR, Brazil
| | - Cintia Pereira Kus
- Fundação de Amparo a Pesquisa em Enfermidades Renais e Metabólicas, Pró-Renal, Curitiba, PR, Brazil
| | | | - Acir José Dirschnabel
- Fundação de Amparo a Pesquisa em Enfermidades Renais e Metabólicas, Pró-Renal, Curitiba, PR, Brazil
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4
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Hirst L, Chakrapani A, Mubeen S. Inborn errors of metabolism and their impact in paediatric dentistry. J Inherit Metab Dis 2022; 45:417-430. [PMID: 35244948 DOI: 10.1002/jimd.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/09/2022]
Abstract
The management of paediatric patients with inborn errors of metabolism (IEM) presents an unparalleled challenge for paediatric dentists owing to the multiplex of interrelated dental manifestations and metabolic management necessitating modifications to dental care. Inborn errors of metabolism describe a largely heterogenous group of genetic disorders namely attributable to a single gene defect essential for a specific metabolic pathway. Approximately 400 disorders have been described with an overall incidence of 1 in 5000 live births worldwide. Clinical presentation is classically inconspicuous and insidious in the neonatal period with pathophysiology attributable to accumulation of toxic by-products which interfere with normal function, or insufficient synthesis of essential compounds. This paper aims to discuss the primary oral and maxillofacial manifestations across the scope of inborn errors of metabolism, whilst also considering how metabolic treatment has the propensity to complicate dental management.
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Affiliation(s)
- Lorna Hirst
- Dental and Maxillofacial Department, Great Ormond Street Hospital, London, United Kingdom
| | - Anupam Chakrapani
- Metabolic Department, Great Ormond Street Hospital, London, United Kingdom
| | - Suhaym Mubeen
- Dental and Maxillofacial Department, Great Ormond Street Hospital, London, United Kingdom
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5
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Römer P, Heimes D, Pabst A, Becker P, Thiem DGE, Kämmerer PW. Bleeding disorders in implant dentistry: a narrative review and a treatment guide. Int J Implant Dent 2022; 8:20. [PMID: 35429255 PMCID: PMC9013394 DOI: 10.1186/s40729-022-00418-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/07/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Considering a high prevalence of congenital and especially acquired bleeding disorders, their heterogeneity and the multitude of possible treatments strategies, a review of the scientific data on this topic is needed to implement a treatment guide for healthcare professionals.
Methods A selective literature review was performed via PubMed for articles describing oral surgery / dental implant procedures in patients with congenital and acquired bleeding disorders. Out of the existing literature, potential treatment algorithms were extrapolated. Results In order to assess the susceptibility to bleeding, risk stratification can be used for both congenital and acquired coagulation disorders. This risk stratification, together with an appropriate therapeutic pathway, allows for an adequate and individualized therapy for each patient. A central point is the close interdisciplinary cooperation with specialists. In addition to the discontinuation or replacement of existing treatment modalities, local hemostyptic measures are of primary importance. If local measures are not sufficient, systemically administered substances such as desmopressin and blood products have to be used. Conclusions Despite the limited evidence, a treatment guide could be developed by means of this narrative review to improve safety for patients and practitioners. Prospective randomized controlled trials are needed to allow the implementation of official evidence-based guidelines.
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6
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Morikawa S, Watanabe K, Usuda S, Miyashita Y, Nakagawa T. Proposed protocol for treatment of severe periodontitis without platelet transfusion in patients with aplastic anemia: a case report. J Med Case Rep 2021; 15:581. [PMID: 34893080 PMCID: PMC8665541 DOI: 10.1186/s13256-021-03170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/21/2021] [Indexed: 12/05/2022] Open
Abstract
Background Aplastic anemia is an intractable disease characterized by pancytopenia, susceptibility to infection, and difficulty in achieving hemostasis. In patients with severe periodontal disease and aplastic anemia, spontaneous bleeding from the gingival tissue due to thrombocytopenia and during brushing is common, which may further exacerbate dental issues. Comprehensive periodontal treatment for patients with aplastic anemia is highly challenging and requires collaboration with a hematologist. Here, we discuss the case of a patient with aplastic anemia and severe periodontitis who was successfully treated in collaboration with our hematology department. Case presentation A 36-year-old Japanese woman with chief complaints of spontaneous gingival bleeding, pain, and increasing tooth mobility consulted our department. She had developed pancytopenia at age 11 years and was later diagnosed with aplastic anemia, making her susceptible to infection due to leukopenia. The results of the initial periodontal examination led to a diagnosis of severe generalized periodontitis (generalized stage IV grade C periodontitis) caused by leukopenia and poor oral hygiene. We adopted a comprehensive treatment plan, including invasive dental procedures. The patient exhibited no postoperative bleeding due to aplastic anemia-induced thrombocytopenia and experienced a good outcome. Conclusions Both physicians and dentists should be aware that immunocompromised patients with aplastic anemia are at risk of developing severe periodontitis with severe alveolar bone resorption if the condition is combined with poor oral hygiene. Even in the presence of aplastic anemia, patients with severe periodontitis can undergo comprehensive dental treatment, including dental extraction and periodontal surgery, if bleeding and susceptibility to infection are controlled. This requires the cooperation of the patient and hematologists and can ultimately contribute to improving the patient’s quality of life.
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Affiliation(s)
- Satoru Morikawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kazuya Watanabe
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Watanabe Orthodontic Office, 1-11-26-2F Kichijoji-honcho, Musashino-shi, Tokyo, 180-0004, Japan
| | - Satoshi Usuda
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoko Miyashita
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taneaki Nakagawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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7
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van Dijk WEM, van Es RJJ, Correa MEP, Schutgens REG, van Galen KPM. Dentoalveolar Procedures in Immune Thrombocytopenia; Systematic Review and an Institutional Guideline. TH OPEN 2021; 5:e489-e502. [PMID: 34805736 PMCID: PMC8595053 DOI: 10.1055/a-1641-7770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background
Dentoalveolar procedures in immune thrombocytopenia (ITP) pose a risk of bleeding due to thrombocytopenia and infection due to immunosuppressive treatments. We aimed to systematically review the safety and management of dentoalveolar procedures in ITP patients to create practical recommendations.
Methods
PubMed, Embase, Cochrane, and Cinahl were searched for original studies on dentoalveolar procedures in primary ITP patients. We recorded bleeding- and infection-related outcomes and therapeutic strategies. Clinically relevant bleeding was defined as needing medical attention.
Results
Seventeen articles were included, of which 12 case reports/series. Overall, the quality of the available evidence was poor. Outcomes and administered therapies (including hemostatic therapies and prophylactic antibiotics) were not systematically reported. At least 73 dentoalveolar procedures in 49 ITP patients were described. The range of the preoperative platelet count was 2 to 412 × 10
9
/L. Two clinically relevant bleedings (2%) were reported in the same patient of which one was life-threatening. Strategies used to minimize the risk of bleeding were heterogeneous and included therapies to increase platelet count, antifibrinolytics, local measures, and minimally invasive techniques. Reports on the occurrence of bleedings due to anesthetics or infection were lacking.
Conclusion
Based on alarmingly limited data, clinically relevant bleedings and infections after dentoalveolar procedures in ITP patients seem rare. Awaiting prospective and controlled studies to further evaluate these risks and the efficacy of therapeutic interventions, we provided our institutional guideline to guide the management of dentoalveolar procedures in ITP patients.
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Affiliation(s)
- Wobke E M van Dijk
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria E P Correa
- Oral Medicine Ambulatory, Hematology and Hemotherapy Center, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Roger E G Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin P M van Galen
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
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8
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Kang SH, Kang MJ. The incidence of postoperative hemorrhage after tooth extraction in patients with thrombocytopenia. J Korean Assoc Oral Maxillofac Surg 2021; 47:190-196. [PMID: 34187959 PMCID: PMC8249185 DOI: 10.5125/jkaoms.2021.47.3.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives The risk of bleeding after tooth extraction in thrombocytopenia patients remains unclear. Therefore, the present study aimed to assess the risk of bleeding after tooth extraction in patients with thrombocytopenia. Materials and Methods The study included 220 patients who had a medical history of thrombocytopenia and underwent tooth extraction (330 teeth). The patients were divided into those who had thrombocytopenia (platelet count <150k) immediately before the tooth extraction, and those who had platelet counts that were between 150k and 250k before the extraction. Bleeding complications were recorded and compared between the patient groups. Results Of the 220 patients, 130 underwent tooth extractions while having thrombocytopenia (platelet count <150k), and 90 had platelet counts that were between 150k and 250k before tooth extractions. Bleeding complications occurred in 11 patients (5.0%) of the 220 patients. Among those 11 patients with bleeding complications, 10 patients (7.7%) had thrombocytopenia (platelet count <150k) of the 130 patients, and 1 patient (1.1%) had a normal platelet count of the 90 patients. There was a significant difference between the patient groups regarding bleeding after extractions (P<0.001). No significant difference in the incidence of post-extraction bleeding was found between the subgroups by platelet count within the thrombocytopenia group. Conclusion Thrombocytopenia (platelet count <150k) increases the risk of post-tooth extraction bleeding. Therefore, bleeding control under the proper evaluation of hemostasis and performing delicate tooth extraction procedures using hemostatic plugs is necessary during the tooth extraction of patients with thrombocytopenia.
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Affiliation(s)
- Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Min-Jun Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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9
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Sandhu S, Sankar V, Villa A. Bleeding risk in thrombocytopenic patients after dental extractions: a retrospective single-center study. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:478-483. [DOI: 10.1016/j.oooo.2019.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 12/18/2022]
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10
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Newland A, Bentley R, Jakubowska A, Liebman H, Lorens J, Peck-Radosavljevic M, Taieb V, Takami A, Tateishi R, Younossi ZM. A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia. ACTA ACUST UNITED AC 2020; 24:679-719. [PMID: 31581933 DOI: 10.1080/16078454.2019.1662200] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Investigate globally, current treatment patterns, benefit-risk assessments, humanistic, societal and economic burden of platelet transfusion (PT). Methods: Publications from 1998 to June 27, 2018 were identified, based on databases searches including MEDLINE®; Embase and Cochrane Database of Systematic Reviews. Data from studies meeting pre-specified criteria were extracted and validated by independent reviewers. Data were obtained for efficacy and safety from randomized controlled trials (RCTs); data for epidemiology, treatment patterns, effectiveness, safety, humanistic and societal burden from real-world evidence (RWE) studies; and economic data from both. Results: A total of 3425 abstracts, 194 publications (190 studies) were included. PT use varied widely, from 0%-100% of TCP patients; 1.7%-24.5% in large studies (>1000 patients). Most were used prophylactically rather than therapeutically. 5 of 43 RCTs compared prophylactic PT with no intervention, with mixed results. In RWE studies PT generally increased platelet count (PC). This increase varied by patient characteristics and hence did not always translate into a clinically significant reduction in bleeding risk. Safety concerns included infection risk, alloimmunization and refractoriness with associated cost burden. Discussion: In RCTs and RWE studies there was significant heterogeneity in study design and outcome measures. In RWE studies, patients receiving PT may have been at higher risk than those not receiving PT creating potential bias. There were limited data on humanistic and societal burden. Conclusion: Although PTs are used widely for increasing PC in TCP, it is important to understand the limitations of PTs, and to explore the use of alternative treatment options where available.
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Affiliation(s)
- Adrian Newland
- Barts Health National Health Service (NHS) Trust , London , UK
| | | | | | - Howard Liebman
- Jane Anne Nohl Division of Hematology, USC Norris Cancer Hospital , Los Angeles , CA , USA
| | | | - Markus Peck-Radosavljevic
- Department of Gastroenterology & Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt , Klagenfurt , Austria.,Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna , Vienna , Austria
| | | | - Akiyoshi Takami
- Department of Internal Medicine, Division of Hematology, Aichi Medical University School of Medicine , Nagakute , Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Zobair M Younossi
- Department of Medicine, Inova Fairfax Hospital , Falls Church , VA , USA
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11
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Karasneh J, Christoforou J, Walker JS, Manfredi M, Dave B, Diz Dios P, Lockhart PB, Patton LL. World Workshop on Oral Medicine VII: Platelet count and platelet transfusion for invasive dental procedures in thrombocytopenic patients: A systematic review. Oral Dis 2019; 25 Suppl 1:174-181. [DOI: 10.1111/odi.13082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/14/2019] [Accepted: 02/27/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - Jennifer S. Walker
- Health Sciences Library University of North Carolina Chapel Hill North Carolina
| | | | - Bella Dave
- Department of Oral Medicine Leeds Dental Institute Leeds, West Yorkshire UK
| | - Pedro Diz Dios
- Medical‐Surgical Dentistry Research Group (OMEQUI) Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela Spain
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12
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Karakatsanis SJ, Papadatos SS, Syrigos KN. Hypoplastic thrombocytopenia and platelet transfusion: therapeutic goals. Hosp Pract (1995) 2019; 47:16-23. [PMID: 30409035 DOI: 10.1080/21548331.2019.1546530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/07/2018] [Indexed: 06/08/2023]
Abstract
Platelet transfusions consist a major part of the management of hypoplastic thrombocytopenia, the latter occurring mainly among patients with hematological malignancies. Platelet transfusions have led to a reduction of deaths attributable to thrombocytopenia-induced bleeding, despite their possible complications; nonetheless, prophylactic administration of platelets to patients with severe thrombocytopenia or before invasive procedures should be based on specific criteria, as well as therapeutic administration during active bleeding. Recently developed ex-vivo procedures have resulted in producing safer blood products, yet it remains unclear whether these pathogen-inactivated products have sufficient efficacy. What is more, another significant problem that remains to be more effectively addressed is the developing refractoriness to platelet transfusions.
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Affiliation(s)
- Stamatis J Karakatsanis
- a Faculty of Medicine, Hematology Unit, 3rd Department of Internal Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Stamatis S Papadatos
- b Faculty of Medicine, Internal Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Konstantinos N Syrigos
- c Faculty of Medicine, 3rd Department of Internal Medicine , National and Kapodistrian University of Athens , Athens , Greece
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13
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Lee ST, Kim JW, Kwon TG. Life-threating outcomes after dental implantation in patient with idiopathic thrombocytopenic purpura: a case report and review of literature. Maxillofac Plast Reconstr Surg 2018; 40:39. [PMID: 30588476 PMCID: PMC6286906 DOI: 10.1186/s40902-018-0178-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with chronic ITP (idiopathic thrombocytopenia) frequently do not require comprehensive medication for daily life. Usually, it had been regarded that postoperative bleeding after a simple or surgical extraction is easily controlled by simple local measures even in patients with ITP. This lack of regular medication usage can sometimes lead practitioners or patients to underestimate the potential life-threatening risk of ITP. There had been no report on postoperative hemorrhage in a patient with ITP related to dental implant surgery. CASE PRESENTATION This report presented a life-threatening postoperative hemorrhage after dental implant surgery in an adult with chronic ITP and subsequent emergency management after severe bleeding and airway compromise. CONCLUSION The presented case emphasizes the thorough hematological evaluation of the patients even for patients who do not take any specific medications for asymptomatic, chronic ITP.
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Affiliation(s)
- Sung-Tak Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Jin-Wook Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Tae-Geon Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
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14
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Akashi M, Kishimoto M, Kusumoto J, Yakushijin K, Matsuoka H, Komori T. Delayed Socket Healing After Dental Extraction in Patients Undergoing Myelosuppressive Chemotherapy for Hematological Malignancy: Incidence and Risk Factors. J Oral Maxillofac Surg 2018; 76:2057-2065. [PMID: 29932940 DOI: 10.1016/j.joms.2018.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/27/2018] [Accepted: 05/17/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study was to measure the frequency and identify factors associated with delayed socket healing after dental extraction in patients undergoing myelosuppressive chemotherapy for hematologic malignancy. MATERIALS AND METHODS This prospective cohort study focused on delayed healing after extraction in patients with hematologic malignancy. Sockets with delayed healing were defined as those with intense pain and bone exposure 1 week postoperatively. Patients with and without delayed socket healing were compared using the Fisher exact test and Mann-Whitney U test with some variables. Receiver operating characteristics curve analysis was conducted to define cutoff values for delayed healing. RESULTS One hundred ninety-four dental extractions in 93 patients (median age, 64 yr; range, 20 to 85 yr) were analyzed. The incidence of delayed socket healing was 7.5% (7 of 93 patients). There was no postoperative bleeding. Older age, type of hematologic malignancy (acute leukemia), shorter time from dental extraction to initiation of chemotherapy, low platelet count or hemoglobin level, requirement for red blood cell concentrate or platelet transfusion, and use of an absorbable hemostatic agent were statistically associated with the occurrence of delayed socket healing. Platelet and hemoglobin cutoffs were 4.6 × 104/μL and 7.7 g/dL, respectively. CONCLUSIONS Although dental extraction can be safely performed in patients undergoing myelosuppressive chemotherapy for hematologic malignancy, oral surgeons should understand the potential risk for delayed socket healing. When considering dental extraction, patients with hematologic malignancy and low hemoglobin or platelet levels should be informed about the possibility of delayed socket healing.
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Affiliation(s)
- Masaya Akashi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Megumi Kishimoto
- Graduate Fellow, Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Kusumoto
- Graduate Fellow, Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kimikazu Yakushijin
- Lecturer, Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Matsuoka
- Associate Professor, Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Professor and Chairman, Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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15
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Petrovic I, Rosen EB, Matros E, Huryn JM, Shah JP. Oral rehabilitation of the cancer patient: A formidable challenge. J Surg Oncol 2018; 117:1729-1735. [PMID: 29723421 PMCID: PMC6135661 DOI: 10.1002/jso.25075] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 02/03/2023]
Abstract
Rehabilitation of oral functions following surgery on the jaws is a goal that is often difficult to achieve. Removable dentures supported by remaining teeth or gum are often unstable and seldom satisfactory. On the other hand, endosseous (dental) implants offer a mechanism to provide stability to the dentures. This review, discusses factors related to the tumor, patient, treatment, and physicians which impact upon the feasibility and success of dental implants in patients with oral cancer.
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Affiliation(s)
- Ivana Petrovic
- Straumann Maxillofacial Dental Implantology Research Fellow, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan B Rosen
- Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan Matros
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph M Huryn
- Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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17
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Blumberg N, Cholette JM, Schmidt AE, Phipps RP, Spinelli SL, Heal JM, Pietropaoli AP, Refaai MA, Sime PJ. Management of Platelet Disorders and Platelet Transfusions in ICU Patients. Transfus Med Rev 2017; 31:252-257. [PMID: 28501326 DOI: 10.1016/j.tmrv.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/19/2017] [Accepted: 04/22/2017] [Indexed: 01/04/2023]
Abstract
Thrombocytopenia or receipt of antiplatelet drugs, with or without bleeding, is a common indication for platelet transfusions in the ICU. However, there is almost no evidence base for these practices other than expert opinion. Also common is use of platelet transfusions prior to invasive procedures or surgery in patients with thrombocytopenia. Likewise, there is no high-quality evidence that such practices are efficacious or safe. Recently, it has become clear that, whether causal or not, patients receiving prophylactic platelet transfusions experience high rates of nosocomial infection, thrombosis, organ failure, and mortality, which increase the urgency and need for randomized trials to assess these practices. Investigational methods of improving the safety and efficacy of platelet transfusions include use of alternate strategies such as antifibrinolytics; use of ABO-identical, leukoreduced, and washed platelet transfusions; and improved storage solutions.
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Affiliation(s)
- Neil Blumberg
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY.
| | - Jill M Cholette
- Critical Care and Cardiology, Department of Pediatrics, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Amy E Schmidt
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Richard P Phipps
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY; Department of Environmental Medicine, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY; Department of Microbiology and Immunology, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Sherry L Spinelli
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Joanna M Heal
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Anthony P Pietropaoli
- Pulmonary and Critical Care, Department of Medicine, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Majed A Refaai
- Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Patricia J Sime
- Pulmonary and Critical Care, Department of Medicine, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
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Maan R, de Knegt RJ, Veldt BJ. Management of Thrombocytopenia in Chronic Liver Disease: Focus on Pharmacotherapeutic Strategies. Drugs 2016; 75:1981-92. [PMID: 26501978 PMCID: PMC4642582 DOI: 10.1007/s40265-015-0480-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Thrombocytopenia (platelet count <150 × 109/L) often complicates chronic liver disease, impeding optimal management of these patients. The prevalence of this manifestation ranges from 6 % among non-cirrhotic patients with chronic liver disease to 70 % among patients with liver cirrhosis. It has also been shown that the severity of liver disease is associated with both prevalence and level of thrombocytopenia. Its development is often multifactorial, although thrombopoietin is thought to be a major factor. The discovery of and ability to clone thrombopoietin led to new treatment opportunities for this clinical manifestation. This review discusses data on the three most important thrombopoietin receptor agonists: eltrombopag, avatrombopag, and romiplostim. Currently, only eltrombopag is approved for usage among patients with thrombocytopenia and chronic hepatitis C virus infection in order to initiate and maintain interferon-based antiviral treatment. Nevertheless, the optimal management of hematologic abnormalities among patients with chronic liver disease, and its risk for bleeding complications, is still a matter of discussion. Thrombocytopenia definitely contributes to hemostatic defects but is often counterbalanced by the enhanced presence of procoagulant factors. Therefore, a thorough assessment of the patient’s risk for thrombotic events is essential when the use of thrombopoietin receptor agonists is considered among patients with chronic liver disease and thrombocytopenia.
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Affiliation(s)
- Raoel Maan
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 's Gravendijkwal 230, Room Ha 206, 3015 CE, Rotterdam, The Netherlands.
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 's Gravendijkwal 230, Room Ha 206, 3015 CE, Rotterdam, The Netherlands.
| | - Bart J Veldt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 's Gravendijkwal 230, Room Ha 206, 3015 CE, Rotterdam, The Netherlands.
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Patel S, Perry MM, Spolarich AE. Oral surgery in a patient with cirrhosis and thrombocytopenia: a case report. SPECIAL CARE IN DENTISTRY 2015; 36:93-8. [PMID: 26625941 DOI: 10.1111/scd.12150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE While most oral surgical procedures can be safely performed in an outpatient setting, certain medical conditions may present a higher chance of postoperative complications. In particular, those predisposing the patient to bleeding abnormalities pose a potential risk when performing such treatments. The authors report a case involving full-mouth extractions in a patient with cirrhosis and thrombocytopenia after obtaining a platelet transfusion. METHODS/CASE A 62-year-old Caucasian female presented to a university special care dental clinic requiring extractions. Her pertinent medical history was remarkable for cirrhosis and thrombocytopenia, with a platelet count of 32,000/uL. Upon medical consultation, the patient was appointed for a prophylactic platelet transfusion. The surgery was rendered uneventfully, and the patient achieved adequate hemostasis without hospitalization. CONCLUSION/CLINICAL RELEVANCE Patients with cirrhosis pose a potential bleeding risk with dental surgical procedures. Pre-operative medical consultation, review of pertinent laboratory values, and prophylactic platelet transfusion allow these patients to be managed safely in an outpatient setting.
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Affiliation(s)
- Seena Patel
- Associate Director of Oral Medicine, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, Arizona
| | - Maureen Munnelly Perry
- Associate Dean for Post-Doctoral Education, Director, The Center for Advanced Oral Health, Associate Professor & Director, Special Care Dentistry, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Arizona.,Associate Director, Central Arizona Region, NYU Lutheran Medical Center, Advanced Education in General Dentistry Program, Mesa, Arizona
| | - Ann Eshenaur Spolarich
- Professor and Director of Research, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, Arizona
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